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Current WHO phase of pandemic alert

Current phase of alert in the WHO global influenza preparedness plan

In the 2009 revision of the phase descriptions, WHO has retained the use of a
six-phased approach for easy incorporation of new recommendations and
approaches into existing national preparedness and response plans. The
grouping and description of pandemic phases have been revised to make them
easier to understand, more precise, and based upon observable phenomena.
Phases 13 correlate with preparedness, including capacity development and
response planning activities, while Phases 46 clearly signal the need for
response and mitigation efforts. Furthermore, periods after the first pandemic
wave are elaborated to facilitate post pandemic recovery activities.
The current WHO phase of pandemic alert is 5.

In nature, influenza viruses circulate continuously among animals, especially

birds. Even though such viruses might theoretically develop into pandemic
viruses, in Phase 1 no viruses circulating among animals have been reported to
cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild
animals is known to have caused infection in humans, and is therefore
considered a potential pandemic threat.
In Phase 3, an animal or human-animal influenza reassortant virus has caused
sporadic cases or small clusters of disease in people, but has not resulted in

human-to-human transmission sufficient to sustain community-level outbreaks.

Limited human-to-human transmission may occur under some circumstances,
for example, when there is close contact between an infected person and an
unprotected caregiver. However, limited transmission under such restricted
circumstances does not indicate that the virus has gained the level of
transmissibility among humans necessary to cause a pandemic.
Phase 4 is characterized by verified human-to-human transmission of an animal
or human-animal influenza reassortant virus able to cause community-level
outbreaks. The ability to cause sustained disease outbreaks in a community
marks a significant upwards shift in the risk for a pandemic. Any country that
suspects or has verified such an event should urgently consult with WHO so
that the situation can be jointly assessed and a decision made by the affected
country if implementation of a rapid pandemic containment operation is
warranted. Phase 4 indicates a significant increase in risk of a pandemic but
does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least
two countries in one WHO region. While most countries will not be affected at
this stage, the declaration of Phase 5 is a strong signal that a pandemic is
imminent and that the time to finalize the organization, communication, and
implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in
at least one other country in a different WHO region in addition to the criteria
defined in Phase 5. Designation of this phase will indicate that a global
pandemic is under way.
During the post-peak period, pandemic disease levels in most countries with
adequate surveillance will have dropped below peak observed levels. The postpeak period signifies that pandemic activity appears to be decreasing; however,
it is uncertain if additional waves will occur and countries will need to be
prepared for a second wave.
Previous pandemics have been characterized by waves of activity spread over
months. Once the level of disease activity drops, a critical communications task
will be to balance this information with the possibility of another wave.
Pandemic waves can be separated by months and an immediate at-ease signal
may be premature.

In the post-pandemic period, influenza disease activity will have returned to

levels normally seen for seasonal influenza. It is expected that the pandemic
virus will behave as a seasonal influenza A virus. At this stage, it is important to
maintain surveillance and update pandemic preparedness and response plans
accordingly. An intensive phase of recovery and evaluation may be required.